118_IV Insertion.1.8.2014._IFN.ICP.pdf

IV Insertion and Management

e-Module IV Insertion and Management

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Purpose

The purpose of this e-learning module is to educate the healthcare team on IV insertion and management

This module is not intended to be all inclusive, but rather provides an overview of salient points related to IV insertion and management.

e-Module IV Insertion and Management

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Who may start an IV?

Peripheral intravenous (PIV) catheters may be

inserted by health care providers whose

competency has been validated.

– RN

– MD

– NP

– PA

– LPN * Check site and local policy

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Policy

• Peripheral IV (PIV) catheters should be changed to a new site every 96 hours.

• The site must be assessed as per protocol

• Frequency of monitoring a peripheral intravenous site is determined by the prescribed therapy (i.e. chemo, blood, TPN, medications), the condition and age of the patient and the practice setting

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Extenuating Circumstances

All PIV catheters should be changed to a new site every 96 hours (4 days) or as needed

• Nursing assessment of patient’s available peripheral venous

access and/or the condition of IV site determines if PIV

should stay in place longer than 96 hours (4 days).

• Extenuating circumstances necessitating extending the above

time frame will require notifying the physician of the need to

extend the time frame due to venous access and obtaining an

order for a maximum of an additional 24 hours for a total of

120 hours (5 days).

e-Module IV Insertion and Management

Peripheral IV that was inserted at

another location may be retained if:

– IV is inserted within 96 hours

– The site is without complications (of pain, redness,

swelling, drainage).

– Equipment (catheter, extension set, needless connector,

and dressing) are appropriate and current as per policy.

– These criteria also applies to peripheral IV’s inserted by

EMS.

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Policy

• All peripheral IVs used intermittently must be flushed every 12 hours and after each use with a prefilled 5ml syringe of sterile sodium chloride 0.9% and clamped.

• All IVs are started with an medlock extension set attached to the catheter.

Medlock Extension set

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Site Selection

• Carefully examine both arms for most appropriate vessels

• Most commonly used veins for placement of IV catheters are:

– Metacarpal

– Cephalic

– Basilic

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Lower Extremity

PIV insertion in a lower extremity:

• requires a valid order

• should utilize the smallest gauge catheter appropriate for the therapy ordered

• requires the patient be on bed rest

• should be changed to an upper extremity or to a central line as soon as possible

• must be placed by NP, PA or MD

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Things to Consider

• Location of vein

• Condition of vein

• Purpose and type of infusion

• Duration of therapy

• Catheter material

• Catheter size needed to delivery therapy

• Patient’s age, diagnosis, prior surgeries, procedures

• Patient activity

• Patient preference

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Avoid

• Do not use veins in affected arm of patients with:

– history of mastectomy

– hemodialysis shunt or fistula

– axillary dissection or biopsy

– surgical procedures

Limb restriction band

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Avoid

• Joint regions

• Sclerotic veins

• Site near recent complication

• Site under restraints; Inner wrist

• Locations with impaired circulation

• Legs and feet

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Getting Started

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Ensure a valid written order

Date

9/3/10

Time

1230

Order

IV Lock

Signature

Bob Cohen,MD

Contact #

Beeper 1913

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Wash Hands

• Standard infection control practices require the use of aseptic technique.

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Identify Patient –

Every Patient - Every Encounter

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Check for Allergies

• Check the allergy band.

• Ask patient if he/she has any known reactions to ChloraPrep or anything else.

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Explain Procedure to Patient

• Tell the patient what you are going to do

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Equipment

• IV start kit

• Angiocatheter

• CLAVE Extension Set

• Saline IV flush

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Prime CLAVE Extension Set

• Flush extension set with normal saline.

• Clave must be cleansed with alcohol after initial flush whenever IV lock is accessed

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CLAVE (bigger picture)

• Never use needles or blunts

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Peripheral IV Start Kit contents:

• Drape

• Tourniquet

• Gloves

• ChloraPrep

• 2X2 gauze

• Hubguard

• Alcohol prep

• Dressing

• Label

• Tape

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Open the IV Start Kit

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Place Drape Under Extremity

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IV Angiocatheter

Open your angiocatheter

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Angiocatheter Gauge Selection

Key points to consider:

• Type of intravenous solution or medication

• Type of procedure or surgery to be performed

• Patient’s diagnosis

• History of IV therapy

• Patient’s activity level

• Patient’s age

• Venous status

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Size Does Matter

• Select the device with the shortest length and the smallest diameter that allows for proper administration of the prescribed therapy.

Note:

• The smaller the gauge number, the bigger the diameter.

• Example: 18 gauge is bigger than 24 gauge.

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16 Gauge & Larger

Uses:

• High-risk surgical procedures

• Large fluid and blood volumes

• Rapid infusions

Uses:

• Surgery

• Improved flow rate for viscous solutions and blood transfusions

• Rapid infusions

18 Gauge

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20 Gauge

Uses:

• Most routine infusions

• Minor surgical procedures

• Routine outpatient procedures requiring IV access

• Appropriate for blood components, when rapid rates are not required

Uses:

• Most routine infusions

– Delivery of antibiotics

– Hydration therapy at slower rates

• Small or fragile veins

22 Gauge

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IV INSERTION VIDEO

Click below to watch a 4 minute video of IV

insertion technique using the angiocatheter

utilized at NSLIJHS.

http://www.bd.com/infusion/products/ivcatheters/autoguard/flash/video.asp

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Upon completion, place angiocatheter in

Sharps Container

• Angiocatheter needle should be retracted prior to disposal in the sharps container (by pressing the white button as demonstrated in the video).

• Remove gloves

• Place all other used equipment in regular garbage.

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Wash your hands

Provide patient education

• Activity restrictions

• Notify nurse if any pain, swelling, burning, redness or discomfort at site, or if any blood in IV lock or tubing

• Avoid any pressure to IV site Signs and symptoms of complications What and when to report signs and symptoms to the health care team Activity and restrictions

How to care for the line

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Document in appropriate area of medical

record:

• Date of insertion

• Time of insertion (in military time)

• Anatomic location of the insertion site

• Type and gauge of catheter

• Patient tolerance

• Patient teaching

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An Untoward Event…..

• Provide appropriate intervention

• Document in progress notes

• Include description of event

– multiple attempts

– hematoma

– infiltration

…………….

infiltration

hematoma Vessicant infiltration

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Adding IV solution to your newly inserted IVLock

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Peripheral IV (PIV) tubing policy

• PIV tubing is changed every 96 hours

• Exceptions: -PPN tubing every 24 hrs

-Blood and blood products every 4 hours or with each transfusion

-Lipid based medications every 12 hours.

-IV tubing used for intermittent administration of IV fluid and medications will be changed every 24 hours.

PIV fluid bag is changed every 24 hours.

Peripheral IV (PIV) fluid policy

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Intermittent Piggyback Policy

• If a secondary line is used intermittently (not through a running main line) and connected directly to a IV lock, that tubing must be changed every 24 hours.

• Any tubing that is not capped after use is considered contaminated and must be discarded immediately.

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IV site assessment policy

• PIV site should be reassessed every 2 hours and documented on the patient care record.

• Assessment includes determining if: dressing is dry and intact, and the site is without redness, swelling, drainage, or pain.

• Frequency for monitoring may be increased based upon prescribed therapy (i.e. chemo, blood, PPN, medications), the condition and age of the patient, and practice setting.

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Attaching an IV infusion

• IV fluid bag (per order)

• IV tubing

• Tubing and bag labels

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Setting the Drip (Infusion) Rate

All pumps in the NSLIJHS have the capacity to calculate infusion rates. In the event of failure, you will need to able to calculate an infusion rate

Drip rate formula:

(Amount in mL) X (tubing drop factor)

Time for delivery in minutes

(100mls to deliver) x (drop factor of 10)

60 min

= # of gtts/min

= 16.6 or 17gtts/min

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IV Solution

• Start IV solution and adjust flow rate.

• Protect against accidental “dumping” of IV fluids (leaving the roll clamp open and allowing rapid infusion of fluid, inadvertently).

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Labeling

• Write date on IV tubing using a sticker

• Write date and time on IV solution using a sticker.

– Include type and amount of solution hung, time started and flow rate

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You have completed this module

Competency validation will occur through return demonstration of an IV insertion.

e-Module IV Insertion and Management

References

NSLIJHS System Nursing Policy and Procedure Committee (2013, June 11). IV insertion (peripheral) adult. Retrieved from: https://nslijhp.northshorelij.com/NSLIJ/policies/Pages/default.aspx

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Post Test

It is required that you take an online post test after module completion.

Click on this Link to Access:

https://nslijhp.northshorelij.com/nursing/EWD/Pages/NursingQuizSystemSYS.aspx?user_facility=system&user_quiz=system-IV-insertion

Passing score = 100%